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American Association for Hand Surgery

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Pediatric Monteggia Fracture-Dislocations and Their Variants
Mark Haft, BS1, Casey M Codd, BA2 and Joshua M Abzug, MD2, (1)University of Maryland School of Medicine, Timonium, MD, (2)University of Maryland School of Medicine, Baltimore, MD

Introduction
Monteggia fracture-dislocation variants have been well documented in adults but most of the literature in the pediatric population is in the form of case reports. The purpose of this study was to investigate the outcomes of true Monteggia fracture-dislocations compared to their variants in the pediatric population.
Materials & Methods
A retrospective chart review was conducted to identify all pediatric patients that sustained acute Monteggia fracture-dislocations and their variants between 2011 and 2020. Patient demographics, mechanisms of injury, fracture pattern, Bado and Letts classification, treatment (operative or conservative), and complications were recorded. Simple statistics were performed.
Results
Of the 93 patients identified, fifteen patients (16.1%) had true Monteggia fracture-dislocations and 78 patients (83.9%) had Monteggia fracture-dislocation variants. Of those that presented with variants, 61.5% (n=48) presented with an olecranon fracture and concomitant radial neck fracture, 21.8% (n=17) had an ulnar shaft fracture and concomitant radial neck fracture, 9.0% (n=7) had a proximal ulna fracture and radial neck fracture, 5.1% (n=4) had a distal ulna fracture and radial neck fracture, 1.3% (n=1) had an olecranon fracture and radial head fracture, and 1.3% (n=1) had an ulnar shaft fracture and radial head fracture.
Of the Monteggia fracture-dislocation variants, 83.3% (n=65) were treated with immobilization alone whereas only 20% (n=3) of the true Monteggia fracture-dislocation injuries were treated with immobilization alone.
Overall, 17 patients (18.2%) had complications during the course of treatment. Of the Monteggia fracture-dislocation variants treated, 16.7% (n=13) had a complication, 6 after being treated with immobilization alone and 7 after being treated with operative intervention. Comparatively, the true Monteggia fracture-dislocations had a 20% complication rate (n=3) with all complications following operative intervention. Of the 22 complications, the most common was a loss of range of motion (36.3%, n=8, all of which were variants), followed by a nerve palsy (13.6%, n=3), loss of reduction (13.6%, n=3, all variants that were initially immobilized), and malunion or nonunion (13.6%, n=3, all variants treated with immobilization).
Conclusions
Pediatric Monteggia fracture-dislocation variants are much more common than true pediatric Monteggia fracture-dislocations. Monteggia fracture-dislocation variants that are treated with immobilization alone had a higher complication rate than true Monteggia fracture-dislocations and therefore these injuries must be followed closely and/or considered for operative stabilization.


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